If you’d like to refer to a specific provider, click here and search for a provider. If you’d like us to choose a provider, continue filling out the form below.

Please fill out this form to refer a patient and you will be contacted by a member of our team.

You may also call 844-867-8444 to speak with one of our Intake Specialists or fax your referral to 916-235-2290.

What Treatment Are You Referring For?

Referring Provider Information

Patient Information

Reason For Referral

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